Can Yemen’s ailing health system be cured?

Political instability has crippled an already struggling healthcare system, spurring many to seek treatment abroad.

Yemen injured
More than half of Yemen's 26 million people live in poverty, and only a few can afford the luxury of medical travel [EPA]

Sanaa, Yemen – With a disquieting resilience, Fatma Mobark stares at the whitewashed walls of the state-run Republican Hospital in Yemen’s capital, Sanaa. She anxiously waits in one of the 20 bed spaces for cancer patients, surrounded by uninviting smells and deafeningly loud corridors.

Mobark was 54 years old when she was diagnosed with bladder cancer two years ago. Last month, her condition worsened. After uncontrollable bleeding and discomfort, her doctors advised that an operation was urgent.

The complex procedure could be fatal or cause permanent paralysis if it went wrong. Accordingly, doctors advised that she seek treatment outside of Yemen. The odds were against Mobark, who by then was both financially and emotionally drained.

Her son, Mohammed al-Qalisi, said the family had already spent more than $30,000 on X-rays and chemotherapy treatments in Jordan after her first diagnosis. He requested assistance from the Yemeni embassy in Jordan and from Yemen’s Ministry of Health, which can grant $600 and two round-trip tickets to patients facing financial difficulties, if their condition is treatable.

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But Qalisi was told by the Ministry of Health to return in three months, and he received no response from the embassy.

“With every passing day, my mother was going from bad to worse,” he told Al Jazeera. “At times, it felt like we were preparing for her to die. The Ministry of Health will do nothing for you. They will only direct you to the cancer centre in the Republican Hospital or to the private organisations.”

Mobark underwent surgery in Jordan in February, and though her family is relieved after the operation’s success, they are still struggling to pay off the costs of the latest round of treatment, which her son said exceeded $35,000.

Mobark is not alone. Thousands of Yemenis struggle to find accessible and trustworthy medical care for heart transplants, knee and bone grafts, cardiac conditions, and spinal injuries.

But Yemen’s political turbulence – the Houthi rebel group controls the capital, the president has fled, and the prime minister is under house arrest – has made the country’s health situation even worse. “No attention has been given to new projects, training or facilities in Yemen. We don’t even have a government,” said Dr Ali al-Ashwal, a cancer specialist at Republican Hospital.

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More than half of Yemen’s 26 million people live in poverty, and only a few have access to the luxury of medical travel. Abdullah al-Salami of Yemen’s Ministry of Health said that roughly 280,000 Yemenis had travelled to Jordan, Egypt, India, and Turkey last year for urgent medical procedures. 

Dwaid Aref, a 20-year-old from Sanaa, recalled being on “a flight of sick people” when he travelled to the National Centre for Tumours Treatment in Cairo, to remove a tumour from his neck in January. 

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Aidroos Bahswaan, 63, and his wife, who hail from Aden, spent the last month in India at Jehangir Hospital in Pune. Bahswaan had knee surgery, and his wife underwent an operation for nasal polyps, or abnormal tissue growth. The overall cost for both surgeries, including travel and accommodations for a month, came to $10,000. 

“In Yemen, it is very, very bad – everything: doctors, lack of equipment,” Bahswaan said. The costs exceeded the amount they would have paid for an operation in Yemen. But, at this age, he was unwilling to take any risks.

Dr Walid M al-Bakili, the head of the MENA and Gulf department of New Delhi-based Apollo Hospitals, attends to several Yemeni patients a year through an exchange programme with India. He said medical care was reliable in his home city of Aden both under British rule and under independent South Yemen, but that it deteriorated after Yemen’s unification in 1990.

“There is a shortage of specialist doctors, facilities and equipment, and this has been going on for a long time. It has worsened in recent years,” he reiterated, claiming that “the government is putting more efforts into the army than Yemen’s sick people”.

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For seven years, Adham Hanif has been shuttling between Mumbai and Aden, working as a translator at some of India’s most renowned hospitals. “Yemenia Airways flights between Aden and Mumbai operate three times a week, carrying roughly 135 patients. Seventy percent of these flights are filled with patients seeking cancer treatment. The rest are looking for transplants or knee operations,” said Hanif.

The Indian embassy in Sanaa disclosed that it issues between 50-80 visas a day for Yemeni nationals travelling to the country, mostly for medical reasons.

Hanif added that, aside from the lack of medical facilities, some doctors in Yemen lack up-to-date training. “Medicine is evolving quickly and some of these doctors lack the expertise to make a well-informed diagnosis,” he said. 

Yemenia Airways flights between Aden and Mumbai operate three times a week, carrying roughly 135 patients. Seventy percent of these flights are filled with patients seeking cancer treatment. The rest are looking for transplants or knee operations.

by Adham Hanif, hospital translator

Doctors admit that the quality of chemotherapy in Yemen’s hospitals is sub-standard.

“There are many types of chemotherapy grades. But, as a result of the growing poverty, Yemeni traders are likely to purchase the least expensive, which are ineffective,” said Ashwal, the cancer specialist.

The burden has fallen on private organisations struggling to cope with a growing number of cancer cases, and complicated injuries due to increased violence in the capital.

Last month, for instance, fighting between Houthi rebels and presidential palace guards in Sanaa left three of the president’s staff in critical condition. They were flown to Jordan and Germany for immediate treatment due to the complexity of the bone graft and transplant surgeries.

While Yemen’s healthcare woes are bad news for patients’ wellbeing, its broken healthcare system is also detrimental to the country’s economic growth.

“Yemenis are spending millions of dollars outside, while the home country is in desperate need to support the national economy, instead of supporting the economy of other countries,” said Dr Shuja Abdin, a professor of cardiology at the University of Sanaa.

Bilal Gulamhussein, a historian based in Aden, identified corruption as the biggest barrier to healthcare reform. “The country is unlikely to see any change” until that happens, he argued, mentioning that patients are often forced to pay bribes or undergo unnecessary blood tests in order to receive treatment.

Until Yemen’s healthcare system sees marked improvements, Bakili believes that medical travel will remain necessary for sick Yemenis in need of complicated procedures.

Meanwhile, given the effective absence of a government and continuing instability, many ordinary Yemenis say they see little hope on the horizon.

Source: Al Jazeera